I tried to quit smoking this month. I lasted a decidedly unimpressive five days. I have tried all the remedies – patches, gums and going cold turkey – but none of them worked. Meeting friends for a patch and a pint down the pub or joining a colleague for a stick of nicotine gum after work just doesn’t have the same social appeal as smoking.
In Sweden, ex-smokers have another option: Snus, small bags of moist tobacco that are placed under your top lip. Consumed in Scandinavia since the mid-19th century, the popularity of Snus rose significantly from the 1970s onwards, as people became increasingly aware of the dangers of smoking. The proportion of male smokers fell dramatically from 40% in 1976 to just 15% in 2002. Almost a third of ex-smokers used Snus when quitting, and those who did were about 50% more likely to succeed.
There are plenty of indicators that the switch from cigarettes to Snus in Sweden has resulted in substantial health benefits. Sweden now has the lowest rate of tobacco-related diseases in Europe and the world’s lowest rate of lung cancer in males. While using Snus is still highly addictive, it is widely held to be between 95% and 99% less harmful than smoking.
One of the key factors behind Snus’s success in weaning people off cigarettes is that it can fulfil some of the social functions of smoking. On a recent visit to Stockholm, I was struck by the number of young people passing round the small distinctive bags of the stuff in the trendy bars of the city centre. As Snus delivers a dose of nicotine at a similar rate to cigarettes, unlike patches or gum it still causes a distinctive nicotine rush. The only obvious downside is the onset of the infamous “Snus-breath” (which is arguably still better than smelling like an ashtray).
Why then does the EU still ban the export of Snus to other EU countries? The answer, as documented in an insightful book by Christopher Snowdon, lies in a combination of stubbornness on the part of anti-tobacco campaigners and the vested interests of the pharmaceutical industry.
The UK was the first country to ban oral snuff in 1988 amid concerns over mouth cancer, and this was followed by an EU-wide ban on new oral tobacco products in 1992. When Sweden joined the EU in 1994, it demanded an opt-out from the ban which allowed Swedish companies to continue selling Snus within its own borders. The EU was forced to oblige, as if it had not done so it is highly likely the Swedish referendum on EU membership would not have passed.
The health justification for the ban was subsequently weakened after numerous studies found that there was no significant correlation between Snus and mouth cancer. The way Snus is prepared significantly reduces the levels of carcinogenic nitrosamines, meaning that despite the popularity of the product Sweden has one of the lowest mouth cancer rates in the EU. Paradoxically, south Asian and African forms of chewing tobacco, which have hundreds of times more carcinogens than Snus, remain readily available in the UK and other EU countries as they are considered to be “traditional” rather than “new” tobacco products.
Two major Snus manufacturers, Swedish Match and Arnold André, used the new medical evidence to challenge the EU ban in 2002. Over the next few years, a series of scientific papers were published claiming that Snus was linked to other diseases, notably pancreatic cancer (a claim that was debunked in a recent major comprehensive study). Many of these studies were published by public health bodies with a strong aversion to the tobacco industry who did not want to accept that Snus could be part of the solution. They wanted an eventual ban on all tobacco products and therefore saw the EU-wide legalisation of Snus as a step backwards, causing them to overlook its potential for harm reduction.
Anti-smoking organisations also played a major role, some of them funded by pharmaceutical companies worried that their share of the lucrative smoking cessation market was under threat. These were the same companies regarded as “stakeholders” by the European commission, and who continue to be consulted regularly over EU tobacco regulation. Often research findings on the health risks of Snus were leaked to the media before their methodology could be properly scrutinised. The scare tactics worked, and in 2004 the European court of justice ruled against the Snus manufacturers to uphold the ban.
The most recent development in the ongoing Snus saga was the resignation of EU health commissioner John Dalli last week, following allegations that a Maltese entrepreneur demanded €60m from Swedish Match in exchange for persuading the commissioner to lift the ban on Snus in forthcoming EU tobacco legislation. This has resulted in a major internal rift. Dalli insists he was unfairly ousted by commission president Jose Manuel Barroso and is now threatening to sue the commission, although he admits he met the Swedish Match lobbyist who was allegedly asked by his Maltese associate for money. However, Barroso denies this and says that Dalli resigned of his own accord. Meanwhile public health campaigners are concerned that the current scandal will delay the tobacco products directive, which would introduce tougher restrictions on the packaging of cigarettes and would potentially extend the ban on Snus to e-cigarettes.
This latest incident underlines the need for more transparency in Brussels and better mechanisms to regulate lobbying. However, some hope that it could also highlight the absurdity of continuing to uphold the ban. A report by the Royal College of Physicians has estimated that if Snus was allowed in Britain, the smoking rate would fall twice as fast and 25,000 lives would be saved in the space of a decade. In the meantime, in the words of smoking addiction expert Professor Robert West, the current policy makes about as much sense as “banning coca leaves and allowing the promotion of crack“.